How To Stop A Heart Attack - Cardiology Let's Play

this video is made possible by support from my streaming platform nebula and from curiositystream stay tuned till the end of the video to watch me lose the plot with the green screen and find out how you can support the channel and i'm just racking up the victories i have carelessly torn this artery it seems patient lost i seem to now be repeatedly killing patients welcome to yet another night shift i'm on night three of three you can probably tell from the bags under my eyes i don't know why i voluntarily upload footage of myself looking crap sleep deprived onto the internet i'll never get any of those beauty vlogger endorsements that i've been craving um i kind of hoped for the olay endorsement but i think they've given away the token brown spot a staple genre of medical youtuber video is the day in the life i'm yet to do one of those i might get around to it at some point but to be honest with the global lockdown my trips to the caribbean and free massages from the pharmaceutical industry have really pretty much dried up so my schedule is looking quite empty these days but that may be a video i'll make at some point but this video is going to be about a specific part of my job which is how we treat and stop heart attacks and the reason i'm doing this is because you guys brought something to my attention a game which is based all around interventional cardiology and that's a game called cardio x that was months ago and i did install it on my phone and then i switched my phone and completely forgot all about it until now but i've just got myself my first ever ipad very exciting so let's let's give it a try opening number uh introduction to intervention perfect so maybe i can talk you through what's going to happen here okay so we start that's clearly somebody's chest in interventional cases you deploy tools down wires to treat complications within the heart see next morning i'm hijacking this video with footage recorded quite a few hours after that last bit overnight since i recorded that first bit i've uh had a case where i managed to save a bit of kit don't worry i've given it a good wash in particular a stent and it's very unusual that we don't use a stent in a procedure and it gets discarded but in this case it was a little bit damaged so it wasn't safe to put inside a patient so we took another one but it means that i've got a stent to show you so i can actually deploy that outside the body so i'll take this opportunity to explain some of the equipment you're going to see in the game and then maybe you'll be a bit more familiar with what it is so a heart attack is caused by an artery supplying the heart there are three main arteries supplying the heart actually there are two but they branch into three main branches any of them can block and that is a heart attack if you don't do anything occasionally the the body will unblock it by itself that the clot will dislodge and go a bit downstream it'll cause damage wherever it ends up but hopefully it'll just be a small amount of muscle but the vast majority of time if you don't do anything that results in a big heart attack which is often fatal so what we try and do is unblock those arteries we go in via the radial artery here in the wrist which is small but big enough to get the tubes that we need to in we used to go at the top of the leg in the femoral artery in the first few decades of this procedure um the artery is much bigger there and occasionally we still do use it but there are far more bleeding issues when you go at the top of the leg rather than the wrist the first thing that goes inside a patient is the catheter which is basically just a long thin plastic tube and this comes in various different shapes so that any old clown like me can find his way to the coronary arteries it's very easy and then this allows us to deliver whatever we want into the arteries supplying the heart to perform an intervention one needs to first put down a guide wire and guide wires are what they sound like they are wires they're made of metal but they come in a bewildering range of different types and if you ever want to understand quite how geeky interventional cardiologists can get engage in a discussion about guidewires and you'll regret all of your life choices as you get bored for the next hour the next thing you might put over the wire is a balloon and this is a balloon that is already used so it doesn't look so neat but when they come new they're very low profile devices so they can get into very narrow spaces and then you inflate and the way you inflate is using one of these which is an indeflator which basically allows you to pump up a balloon and then after that you might put a stent in it's got the same principle as the balloon there's a balloon inside but outside there is this metal tube called a stent which kind of blows up to about the size of the spring inside your biro but you'll see the struts are far far thinner stents can be made of various different types of things they're metal they initially were stainless steel but those bare metal stents um used to have problems with their their narrow very quickly and cause more problems so now pretty much all stents put in have a ab luminal polymer coating with a drug that seeps out of the device over months these are called drug eluting stents and they have much better longevity than the bare metal stents typically their cobalt chromium like this one advanced levels will challenge your decision making skills with thrombosis that's clots calcified plaques that's narrowing in the artery with calcium so chalk basically which is deposited as we get older and they can be really hard to crack some calcified blockages perforations that's when someone like me pokes something through the side of the artery which is bad and even bifurcation lesions bifurcation is where an artery sort of splits into two that's called a bifurcation and then those are much more complex cases because you might need to stent into both branches we can move the camera around okay that's nice you can see we're changing our angle where we look at the heart so that is analogous to the radiographer moving the x-ray camera around so here we're going to inject some contrast there you go perfect now we are seeing uh that there is a narrowing you have to advance your wire to allow a balloon to treat the stenosis that's right so we push our wire through the narrowing and then we can put kit over the top in reality uh narrowings don't glow red like that okay so now we're opening our toolbox balloon uh okay three millimeters in diameter that gives you an idea that's pretty average of the kind of widths we're dealing with here so now we'll advance our balloon down to the down to the narrowing and now we're gonna inflate whoa fireworks great job sadly those messages don't pop up on my screen in real life okay now we deflate the balloon we don't leave that inflated now we inject some more dye look at that beautiful it's uh we've treated one lesion successfully these thrombi clots can be aspirated with an aspiration catheter aspiration catheter is basically like a tube that we just apply suction to the back of and take everything and suck everything out like a like a hoover like a vacuum cleaner sorry i don't want to use trade names unless they sponsor me okay we've turned it on so let's suck back wow there's all kinds of pyrotechnics going on here if only real life was this exciting to look at let's hope it's done the trick i'm not actually sure what's going on here there seems to be some squadron of alien ships flying away from the artery uh let's see what's going on oh whoa whoa what's going on this doesn't look good dissection aha so uh i have carelessly torn this artery it seems drug eluting stint let's pass this down the archery stent opposed patient stabilized life saved victory that's what it says victory and that's what i say at the end of every case i raise my fists to the heavens and i say i won victory okay case number two split focus i've just realized something actually that you can see the catheter is coming from below the heart here and looping around the arch of the aorta and then into the coronary arteries indicating that the catheter has been inserted in the groin the femoral artery which is a bit old-fashioned now we don't really do that in the uk or europe or asia very much maybe about 10 of cases are done that way for other reasons but we tend to go in the wrist as i mentioned earlier the one country which is really lagging behind out of modern countries is well i mean there's there's no prizes for guessing yes it's the united states of america where frameral access is still more common and the reason we prefer the wrist is because there are far fewer bleeding complications the patient can sit up straight away afterwards so i can infer from this that this app must be american but anyway onto the case i should have noticed that in the first case actually we've got what looked like two narrowings here so let's see okay that's moving my wire don't do that let's see what we're dealing with let's inject some dye okay so that looks like we've got a narrowing in the circumflex artery and the left anterior descending artery so we've got two wires we'll put one down each archery let's inject them so let's move this okay so we've put two wires down the arteries now let's treat our led lesion first and put a balloon on okay it's giving me two diameter options five is pretty big so i'm going to take three millimeters and length well in reality we don't use six millimeter balloons very often but um they seem keen on them in this game so let's do that right inflate [Music] boom job done okay so that's the left anterior descending or the widowmaker artery treated uh i don't call it the widowmaker i don't think anybody in the biz does okay get had to give it another blow uh there's still a bit of glowing red which again doesn't exist in real life but i think it's telling me i need to go again interventionalist one patient stabilized life saved victory and i'm just racking up the victories i'm like the michael jordan of androplasty fly by wire case number three so case number three uh it appears that the patient is blue and it's snowing inside their chest um i've got to say i am definitely here for this equal opportunities no discrimination game we treat patients of all colors and all weather conditions and inject so we've got some narrowings in the circumflex artery again so we've already got a balloon selected so i'm going to put the balloon across the lesion here just blow that up bang okay jolly good um uh okay i mean that was pretty easy like i didn't really do anything there but yet another victory 3-0 demonstrating effective stenting the others had such cool names and this one's so boring okay this patient is back to multicolored good this is a dissection it deals damage to the patient over time what a strange sentence des stents that's like saying pin number because des is drug eluting stent so drug eluting stent stents can treat dissections whereas balloons cannot okay this is your patient's health if the blue portion runs out you will lose the patient fatality complications like dissections cause recoverable damage which appears red if only we had a health bar running across the top of the screen in real life it would make life so much easier so we've got a few uh problems dissections again i like the way the dissections glitter it's very pretty we've got a purple patient this time with some sort of galaxy theme uh okay let's get out let's let's inject some dye all right how on earth have we got dissections like that so dissections let's just pause here dissections can be iatrogenic meaning caused by the operator but you can also get spontaneous dissections particularly in women they tend to be affected by this more and this is where the lining of the artery can can tear and it can range from just a small bit of damage to actually a very severe problem which causes a heart attack and the end result is the same as a conventional if you like heart attack which is caused by atheromatous plaque or all the usual things you know about cholesterol smoking all that stuff which blocks the artery whereas this is a different mechanism it's caused by a dissection but the end result of causing heart muscle to die can be the same but we treat them in slightly different ways so maybe these these are spontaneous dissections that have occurred which would be rather bad luck to have happened in three different branches right patient lost i was too busy guessing to you guys oh dear the patient succumbed to blood loss from a dissection dissections occur when a tool damages a blood vessel or stretches a vessel beyond its normal radius they can be treated using stents well i've got to play again unfortunately we can't reset in real life all right i better move a bit faster this time so let's get our wire down there asap i might just occlude the proximal vessel just at the beginning of this branch [Music] and so what i've done now is occluded the vessel and hopefully bought myself a little bit of time do some other things because now there won't be as much blood getting to the dissections and our patient won't bleed out um i think my early confidence might have been misplaced i seem to now be repeatedly killing patients okay a little bit of time has passed i've killed about three or four patients and finally i have managed to get through this perforation perturbation well i can kind of guess where this one's going to go this is a perforation that causes more damage than a dissection and can only be treated with a covered ptfe stent so a normal stent is just a wire mesh whereas a ptfe cupboard stent has a material so it can actually seal a perforation in an artery perforations are also bad news and they can be caused uh by over aggressive inflation of a balloon or a wire and pushing you know a stiff wire or some of the other things we we do something called rotablation which is a diamond bit it actually is diamond bit drill that goes into the artery and and sounds like a dentist drill and sometimes that can cause a perforation that's happened to me um and the patient was fine in the end but it's extremely scary at the time polytetrafluoroethylene stent 2.5 millimeters six millimeters in length they love their 60 millimeter stands if a ptfe stent covers a side branch that branch will die permanently damaging the heart well that's a good point uh that sometimes you have to sacrifice a small branch like a little b road coming off the main motorway uh in order to maintain the patency of that main vessel the main motorway and um you know that's just one of the many many decisions you have to make on the fly during a case whoa whoa how are there four perforations what the hell has been going on in this case oh my goodness me right get down the main vessel here nope my y doesn't want to go the right way this this is fairly realistic it can be a real hassle getting wires into the right place oh my goodness we're going to have to put so many stents here okay let's put a long stent you always want to try and treat the distal lesion first particularly with a covered stent because you can't get stuff through it once it's in very easily okay that seems to be all right okay so first stent is in two of the perforations are fixed that was bad i wasn't paying attention to the proximal end and i haven't covered it so i'm gonna have to put another stent in it says life saved in victory but uh not too sure about that one is very i think this is the hottest room in the hospital i've had to turn my one little fan off for the microphone so i'm sweating like a chiropractor in a medical malpractice lawsuit okay atherectomy drill two millimeter burr a little bit big okay that's what we'll go for uh first drag the drill into position proximal to the lesion okay that's easy hold the drill to go through let's see if it gives a drill sound effect that's okay that i mean that's a bit of a misrepresentation because this is really quite complex high-risk stuff uh so it's not that easy or at least that's what we tell people i think i'm going to end there because i need to stop this interventional cardiology to do some interventional cardiology i don't know if you found that useful in any way it was kind of fun it seems like the nerdiest possible game i can imagine i have no connection to the makers of the game i have no idea who made it or anything but uh you know why don't you guys give it a try and see how far you get i'll probably play a little bit more and see what else they have but so far i mean obviously they've had to simplify things uh i think it's a nice little introduction to the kind of bread and butter of of what i do and what thousands of interventional cardiologists do around the world um let me know your thoughts i don't know if this video was uh particularly interesting or useful the raw footage for this video ran way over an hour so i've had to be pretty brutal chopping it all down so that this video wasn't insanely long if you're a masochistic kind of person that wants to see more of me wittering on then head on over to nebula where i'm including a few of the bits that i cut out from this version instead of this sponsor read nebula is a streaming service that i started up along with a bunch of fellow educational creators to make stuff that we want without worrying about youtube's algorithm it gives us freedom to experiment and it's also supporting nebula originals that are exclusive to the platform you can get a subscription to nebula bundled in for no additional cost when you sign up to curiosity stream who have supported me consistently for over a year and who helped make nebula a success curiosity stream is the perfect partner to nebula as it's home to thousands upon thousands of high quality documentaries you've just heard a little bit about what i do for a living but long time viewers of the channel will know that my dream right until my mid-twenties was to be a space doctor and now the closest i can get is to live vicariously while watching the extensive space collection including the very recent story of the spacex crew dragons mission so what would you pay for access to nebula and curiosity stream 15 a month how about 15 a year at the moment they're offering 26 off their annual price meaning you can get nebula and curiosity stream for 15 for an entire year but only when you sign up via the link below and use the code medlife so if you find the videos that i make interesting or useful signing up really supports me as well as giving you something in exchange until next time look after your heart unless you want to end up with someone blowing up balloons inside you actually that sounds really weird doesn't it

Channel: Medlife Crisis

Views: 117,794

Rating: 4.9619679 out of 5

Keywords: Medlife Crisis, Medicine, Science, Education, Comedy, Doctor, Cardiology, Medical School, Biology, CardioEx, Let's play, Walkthrough, Gaming, Gamer, Medical game, Doctor game, Heart attack, Health, Heart disease, Angioplasty, Interventional cardiology, Stent, Bypass, Dr Mike

Id: xnkYeFPUyrs

Length: 21min 2sec (1262 seconds)

Published: Sun Sep 27 2020

Reddit Comments

[u/Onion01]

The video is not only funny, but one of the best and clearest demonstrations of a balloon and stent deployment I’ve ever seen

[u/PeakyFinders90]

In my opinion, the BEST medical YouTube channel put there. The guy is hilarious and professional at the same time, plus very educational and thoroughly evidence-based in everything. Check him out!